Suspected Adrenal Crisis Flashcards
Suspected Adrenal Crisis Medical Directive
What are the INDICATIONS?
What are the S+S?
A patient with primary adrenal failure who is experiencing clinical signs of adrenal crisis
Dizziness
Nausea
Vomiting
Abdominal pain / cramping
Headache
Light headedness
Blurred vision
Dehydration
Loss of appetite
Fatigue
Diaphoresis
Weakness
Fever
Loss of consciousness
Confusion
Poor sleep/insomnia
Lethargy
GI disturbances
Hypotension / low blood pressure
Anxiety, restlessness
Suspected Adrenal Crisis Medical Directive
What is hydrocortisone?
What is an adrenal crisis?
an injectable corticosteroid for production of cortisol and
aldosterone (inflammation management)
Hormones produced in adrenal glands - cortisol, adrenaline, aldosterone
A severe lack of cortisol - which usually regulates BP, metabolism, and reduciton of inflammation
– results in decresed BP, BGL, and weight
– results in fatigue, N/V, leg cramps
Caused by:
- hypopituitary
- hemorrhage
- autoimmune diseases
- infecitons
- cancer
- organ damage
Suspected Adrenal Crisis Medical Directive
Why is cortisol important for proper body function?
What link does it have to our sympathetic nervous system?
Its receptors are located on every organ
It’s a hormone that regulates the body when stressed i.e. blood pressure, metabolism, and decrease of inflammation
When the body shifts into “fight or flight” mode (sympathetic response) the sympathetic nervous system will signal the adrenal glands to release both epinephrine and cortiol.
Suspected Adrenal Crisis Medical Directive
How does cortisol impact use of glucose?
Where is cortisol produced?
It increases the availability by releasing the stores of glucose
The adrenal glands ontop of the kidneys
Suspected Adrenal Crisis Medical Directive
Does cortisol/hydrocortisone affect our immune system?
Yes - you become more susceptable
Suspected Adrenal Crisis Medical Directive
What are the CONDITIONS for hydrocortisone?
What are the CONTRAINDICATIONS?
Paramedics are presented with a vial of hydrocortisone for the identified patient
AND
Age-related hypoglycemia
OR
GI symptoms (vomiting, diarrhea, abdominal pain)
OR
Syncope
OR
Temperature ≥38C or suspected history of fever
OR
Altered level of awareness
OR
Age-related tachycardia
OR
Age-related hypotension
Allergy or sensitivity to
hydrocortisone
Suspected Adrenal Crisis Medical Directive
What is the ROUTE and TREATMENT PLAN for hydrocortisone?
Who does the adminitration apply to?
What should the dose be rounded to the nearest of?
ROUTE - IM and IV
Dose - 2mg/kg
Max. Single Dose - 100mg
Dosing Interval - N/A
Max # of Doses - 1
PCPs authorized for PCP Autonomous IV
10mg
Suspected Adrenal Crisis Medical Directive
True or False - hydrocortisone is not carried by paramedics
What are examples of underlying issues/stressors?
TRUE
Hypoglycemia
Hypotension
Gastrointestinal issues
Fractures
Suspected Adrenal Crisis Medical Directive
What should you do if the patient presents with signs and symptoms consistent with the medical directive, AND his/her OWN medication is available?
Should these pts be transported to a receiving facility?
administer 2mg/kg up to 100 mg IM/IV of hydrocortisone
Yes for additional care and follow up
